Inpharma 1289 - 26 May 2001

Thrombolytics + heparin improveoutcome after unsuccessful CPR?Administration of thrombolytics plus heparin may

improve patient outcome following initiallyunsuccessful cardiopulmonary resuscitation (CPR), sayresearchers from Germany. Although thrombolytictherapy during CPR has traditionally been regarded ashazardous, because of the potential for severe bleedingcomplications associated with CPR procedures, suchcomplications did not occur in their study.

They conducted a prospective intervention study in90 patients in whom CPR for out-of-hospital heart arrestfailed to achieve return of spontaneous circulationwithin 15 minutes.* During the first year, patientsreceived only CPR (control group; n = 50).Subsequently, patients were treated with a bolus dose ofheparin 5000U and IV alteplase 50mg over 2 minutes,repeated after 30 minutes if required. The trial wasstopped after interim analysis on data for 40 patientsbecause of ‘substantial improvement in early patientoutcome with heparin and rt-PA [alteplase]’, note theresearchers.

The proportion of patients with return of spontaneouscirculation was substantially higher in the treated groupcompared with controls [68 vs 44%; odds ratio 2.65(95% CI 1.11–6.25)] and a greater number were able tobe admitted to a cardiac intensive care unit [58 vs 30%;odds ratio 3.15 (95% CI 1.32–7.69)]. A greaterproportion of the treated group were alive at 24 hoursafter heart arrest (35 vs 22%) and were subsequentlydischarged from hospital (15 vs 8%).* An advanced cardiac life support unit arrived within a mean of 9minutes after callout.

Bottiger BW, et al. Efficacy and safety of thrombolytic therapy after initiallyunsuccessful cardiopulmonary resuscitation: a prospective clinical trial. Lancet357: 1583-1585, 19 May 2001 800861357

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Inpharma 26 May 2001 No. 12891173-8324/10/1289-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved